Macronutrient Composition and Sodium Intake of Diet Are Associated with Risk of Metabolic Syndrome and Hypertension in Korean Women

<div><p>Hypertension and hypertriglycemia are the most important contributors to metabolic syndrome (MetS) and cardiovascular disease risk in South Koreans with a relatively lean body mass. These major contributors differ from those identified in Western populations. This study aimed to identify the characteristics of the Korean diet associated with increased risk of MetS, whose prevalence has been steadily increasing in South Korea. On the basis of data collected from 5,320 subjects by the 2007–2008 Korean National Health and Nutrition Examination Survey, 3 dietary patterns were identified using factor analysis and their association with the risk of MetS and its components was examined. The balanced Korean diet, a typical Korean diet of rice and kimchi intake supplemented by a variety of foods had a desirable macronutrient composition and was associated with a lower risk of elevated blood pressure (OR=0.61, 95% CI=0.45–0.84) and hypertriglyceridemia (0.69, 0.49–0.88) in men and a lower risk of elevated blood pressure (0.59, 0.41–0.85) and MetS (0.67, 0.47–0.96) in women. The unbalanced Korean diet, characterized by a high intake of carbohydrates and sodium and little variety, was associated with a higher risk of MetS (1.44, 1.03–2.01) and elevated blood pressure (1.41, 1.00–1.98) in women. The semi-western diet, characterized by a relatively high intake of meat, poultry, and alcohol, was associated with a lower risk of low high-density lipoprotein cholesterol (0.70, 0.54–0.89) in women. Thus, macronutrient composition and sodium intake are associated with the risk of MetS and prehypertension in women. Maintaining a desirable macronutrient composition and avoiding excessive consumption of carbohydrates and sodium should be emphasized for prevention of MetS and hypertension in South Korean women. </p> </div

Metabolic syndrome risk and macronutrient composition of balanced Korean diet and unbalanced Korean diet.

<p>A and D: Macronutrient composition by quintiles (Q1: lowest, Q3: middle, Q5: highest; Q3 and Q5 was calculated on the base of Q1); % of energy is the percentage of energy obtained from carbohydrate, protein and fat; A dotted line is recommended intake of carbohydrate for Korean; ‡, p for trend <0.001. B and E: Multivariate OR and 95% CI (bar) of elevated blood pressure; *, Significant odd ratio, ‡, p for trend <0.001; Adjusted for age, smoking, alcohol and physical activity. C and F. Multivariate OR and 95% CI (bar) of hypertriglyceridemia for men and metabolic syndrome for women; *, Significant odd ratio, †, p for trend < 0.05; Adjusted for age, smoking, alcohol and physical activity.</p

Kaplan-Meier survival curve for mortality in (A) patients with 24 h-residual urine volume ≥100 ml (P = 0.764 by log-rank test) and in (B) patients with 24 h-residual urine volume <100 ml (P = 0.005 by log-rank test).

<p>Kaplan-Meier survival curve for mortality in (A) patients with 24 h-residual urine volume ≥100 ml (P = 0.764 by log-rank test) and in (B) patients with 24 h-residual urine volume <100 ml (P = 0.005 by log-rank test).</p

Causes of deaths in each group.

<p>Causes of deaths in each group.</p

Cox regression analysis of all-cause mortality.

<p>^aAdjusted for age, gender, diabetes mellitus, previous cardiovascular disease history, duration of dialysis, serum level of iron, ferritin, albumin, intact PTH, hsCRP, total cholesterol and single-pool Kt/V.</p><p>^bAdjusted for age, gender, diabetes mellitus, previous cardiovascular disease history, duration of dialysis, serum level of iron, ferritin, albumin, intact PTH, hsCRP, total cholesterol and weekly Kt/V.</p><p>HD, hemodialysis; hsCRP, high sensitivity C-reactive protein; PD, peritoneal dialysis; ERI, erythropoietin resistance index; HR, hazard ratios; CI, confidence interval; P, P-value.</p><p>Cox regression analysis of all-cause mortality.</p

Hazard ratios for all-cause mortality by category of ESA responsiveness based on a combination of ESA dosage and hemoglobin level.

<p>Adjusted model included for age, gender, diabetes mellitus, previous cardiovascular disease history, duration of dialysis, serum level of iron, ferritin, albumin, intact PTH, hsCRP, total cholesterol and Kt/V.</p><p>^aMedian value of ESA dose in hemodialysis patients</p><p>^bMedian value of ESA dose in peritoneal dialysis patients.</p><p>ESA, erythropoiesis-stimulating agent; Hb, hemoglobin; N, number of patients; HD, hemodialysis; PD, peritoneal dialysis; HR, hazard ratios; CI, confidence interval; P, P-value.</p><p>Hazard ratios for all-cause mortality by category of ESA responsiveness based on a combination of ESA dosage and hemoglobin level.</p

Baseline characteristics of the study populations.

<p>Baseline characteristics of the study populations.</p

Univariate and multivariate Cox regression analysis for infection-related mortality and hospitalization serum ALP tertile.

<p>Univariate and multivariate Cox regression analysis for infection-related mortality and hospitalization serum ALP tertile.</p

Multivariate Cox regression analysis of mortality in study populations.

<p>Multivariate Cox regression analysis of mortality in study populations.</p

Serum Gamma-Glutamyltransferase Levels Predict Clinical Outcomes in Hemodialysis Patients

<div><p>Background</p><p>Gamma-glutamyltransferase (GGT) is a biomarker of liver injury. GGT has also been reported to be a marker of oxidative stress and a predictor of mortality in the general population. Hemodialysis (HD) patients suffer from oxidative stress. The aim of our study was to investigate the relationship between serum GGT levels and clinical outcomes in HD patients.</p><p>Methods</p><p>A total of 1,634 HD patients were enrolled from the Clinical Research Center registry for end-stage renal disease, a prospective cohort in Korea. Patients were categorized into three groups by tertiles of serum GGT levels. The primary outcome was all-cause, cardiovascular, or infection-related mortality and hospitalization.</p><p>Results</p><p>During the median follow-up period of 30 months, the highest tertile of serum GGT levels had a significantly higher risk for all-cause mortality (hazard ratio (HR) 2.39, 95% confidence interval (CI), 1.55–3.69, P<0.001), cardiovascular mortality (HR 2.14, 95% CI, 1.07–4.26, P = 0.031) and infection-related mortality (HR 3.07, 95% CI, 1.30–7.25, P = 0.011) using tertile 1 as the reference group after adjusting for clinical variables including liver diseases. The highest tertile also had a significantly higher risk for first hospitalization (HR 1.22, 95% CI, 1.00–1.48, P = 0.048) and cardiovascular hospitalization (HR 1.42, 95% CI, 1.06–1.92, P = 0.028).</p><p>Conclusions</p><p>Our data demonstrate that high serum GGT levels were an independent risk factor for all-cause, cardiovascular, and infection-related mortality, as well as cardiovascular hospitalization in HD patients. These findings suggest that serum GGT levels might be a useful biomarker to predict clinical outcomes in HD patients.</p></div